Despite differences between these two approaches in Psychiatry, there is agreement regarding the poor prognosis of type I bipolar disorder, particularly when psychotic traits are observed. Early diagnosis and treatment are therefore a challenge for both, but their limitations are inherent to their respective approaches. In Anglo-Saxon countries, if the criteria are met for bipolar disorder, treatment is decided at the risk of over-diagnosis and stigmatization of false positives. In Francophone countries, even if the criteria for bipolar disorder are met, it is still necessary that the psychopathological analysis of the disorder in the developmental framework of adolescence confirms that the disorder is stable, at the risk of later treatment and of increase of insufficiently treated false negatives. A reconciliation of these fields may limit the above side effects.